Managing pain

Labor is as uniquely different as the woman who experiences it. Everyone has a different pain tolerance level, and reacts to pain in a personal way. In the hospital, you will be asked to rate your pain on a scale of 0 – 10, and set a pain management goal. It is important to discuss your options with your healthcare provider to determine your preference about pain management prior to the onset of labor.

Every woman experiences the pain of labor and delivery differently. Many factors affect the pain you may feel. These factors include the size and position of the baby, the strength of the contractions, and your own pain tolerance. The first step in managing your pain is to learn about your options and make a tentative plan. But stay flexible. The course of a baby’s birth can be unpredictable.

You may not need or even want pain medication. Many women have babies without any pain medication. They manage the intense feelings of childbirth in other ways. Relaxation and breathing exercises, hypnosis, and massage are some common ways to manage pain. Such methods are often called “natural” childbirth.

You may change your mind as labor progresses. Labor often hurts more than you anticipate. Changing your mind about pain relief is not a sign of weakness. Some women find that pain-relieving medication helps them feel more in control and less tired during childbirth. Doctors sometimes suggest pain medication to help labor progress or if complications arise.

The two main types of pain medications used in labor and delivery are analgesics and anesthetics.

• Analgesics, such as narcotics, are medications that help relieve pain. They can lessen pain during labor and delivery, but do not completely get rid of it. They can also reduce anxiety and help you relax.
• Anesthetics are medications that can block most feeling, including pain. Depending on how and where they are given, they can act on a specific area or region of your body, or they can act on your whole body.
  • Local anesthetics, such as lidocaine, act only on a specific area of your body.
  • Regional anesthetics, such as epidural and spinal blocks, act on a specific region of the body. Often called “nerve blocks,” these options can be used for both vaginal and cesarean deliveries (c-sections).
  • General anesthetics block most sensation, including pain, and cause you to lose consciousness completely. (They “put you out.”) They are only used when absolutely necessary, such as for an emergency c-section.

All types of pain medication may affect your labor - and your baby - though most of these effects are temporary. Use the table below to learn more. Then discuss the options with your healthcare providers.

What it is

Analgesics (general pain relieving medications, like narcotics)

How it’s given

• Usually given through an IV or as an injection (shot) into a muscle. Can also be injected into the epidural space or into the spinal fluid. (See “how it’s given” under epidural block and spinal block for more information on this method of delivery).
• If given through an IV or injected into a muscle, the medication is carried in your bloodstream - so your baby gets it, too. How it affects your baby depends on how much and how close to delivery the drug is given.

Actions and potential benefits

• Can lessen pain, reduce anxiety, and help you relax during labor.
• Does not block all sensation and feeling.
• Does not cause you to lose consciousness.
• Does not slow down labor or interfere with contractions.

Potential risks or side effects

For you:

• Does not completely eliminate pain.
• May cause drowsiness or trouble concentrating.
• May decrease your memory of labor.
• May cause nausea, vomiting, or itching
• May decrease blood pressure or slow your breathing
• May give you an unwell or unhappy feeling.

For your baby (if given too close to birth):

• May cause sleepiness, which may make it harder to breastfeed (“latch on”) immediately after birth.
• May slow breathing and reflexes, and make it hard for your baby to stay warm.

What it is

Pudendal Block (a local anesthetic)

How it’s given

• Injected into the vaginal area.

Actions and potential benefits

• Used to numb the vaginal area, usually before an episiotomy.

Potential risks or side effects

• Numbs only the vaginal area. Provides no relief from contraction pain.
• Rarely causes any negative effects on you or your baby.

What it is

Epidural block (a regional anesthetic)

How it’s given

• A local anesthetic is used to numb an area on your lower back.
• A needle is inserted into the epidural space around your spinal canal. Then a thin catheter is threaded through it. The needle is removed and the catheter stays in place.
• You must lie or sit completely still while the needle and catheter are being inserted. This helps prevent touching a spinal nerve or vein, or piercing the spinal cord, which can cause unwanted side effects.
• It takes 10 to 20 minutes to place an epidural catheter, and another 10 to 20 minutes for the medication to take effect.
• Once the catheter is in position, you can move around, but may not be able to walk

Actions and potential benefits

• Blocks most feeling from your waist down.
• Takes 10 to 20 minutes to take effect.
• Can be used throughout labor.
• Medication can be given through the catheter more than one time, with dosage increased or decreased as needed.
• With stronger medications, can also be used for c-section.

Potential risks or side effects

For you:

• If labor doesn’t progress as expected, effects of a spinal block may wear off too soon.
• Numbness may make it more difficult to push, and may also cause loss of bladder control (temporarily requiring a catheter).
• If numbness extends to the chest, breathing may seem difficult, which may make you anxious.
• If the needle pierces the sac around the spinal cord, you may develop a bad headache, which may last several days. This is treatable.
• You may have back pain.
• Your blood pressure may drop. If this happens, you will receive IV fluids to help bring your blood pressure up.
• You may feel lightheaded, dizzy, or nauseous, or hear buzzing in your ears.
• If a nerve is touched when the epidural needle is being placed, you may feel a brief tingling sensation down one leg. Rarely, the needle may cause nerve injury.
• If medication goes into a vein, it could cause dizziness or, rarely, seizures.
• Though rare, there is risk for allergic reaction, blood clot, blood vessel injury, epidural abscess, swelling, or infection.

For your baby:

• May make your baby sleepy, which may make it harder to breastfeed immediately after birth.
• A drop in your blood pressure may cause your baby’s heart rate and breathing to slow down.

What it is

Spinal Block (a regional anesthetic)

How it’s given

• A small needle is inserted directly into the spinal canal in your lower back.
• A small amount of medication is then injected into the spinal fluid.
• A spinal block is given only once during labor, usually just before delivery.

Actions and potential benefits

• Blocks most feeling from the chest down.
• Takes effect immediately, and lasts 1 to 2 hours.
• With stronger medications, can also be used for c-section.

Potential risks or side effects

For you:

• If labor doesn’t progress as expected, effects of a spinal block may wear off too soon.
• Numbness may make it more difficult to push, and may also cause loss of bladder control (temporarily requiring a catheter).
• If numbness extends to the chest, breathing may seem difficult, which may make you anxious.
• If the needle pierces the sac around the spinal cord, you may develop a bad headache, which may last several days. This is treatable.
• You may have back pain.
• Your blood pressure may drop. If this happens, you will receive IV fluids to help bring your blood pressure up.
• You may feel lightheaded, dizzy, or nauseous, or hear buzzing in your ears.
• If a nerve is touched when the epidural needle is being placed, you may feel a brief tingling sensation down one leg. Rarely, the needle may cause nerve injury.
• If medication goes into a vein, it could cause dizziness or, rarely, seizures.
• Though rare, there is risk for allergic reaction, blood clot, blood vessel injury, epidural abscess, swelling, or infection.

For your baby:

• May make your baby sleepy, which may make it harder to breastfeed immediately after birth.
• A drop in your blood pressure may cause your baby’s heart rate and breathing to slow down.

What it is

General anesthesia (Causes you to lose consciousness and blocks most sensation, including pain)

How it’s given

•  The anesthesia medication is given through an IV or as an inhaled gas – or both.
• After you’re asleep, a tube may need to be inserted through your mouth into your airway to help you keep breathing.
• Note: Since food or liquid in your stomach can cause major risks, you may be told not to eat or drink once labor has started. Ice chips and small sips of water are usually okay. You may also be given an antacid to reduce stomach acid.

Actions and potential benefits

• Can be started quickly and causes rapid loss of consciousness.
• Blocks most sensation, including pain.
• Used only when absolutely necessary, such as for an emergency c-section.

Note: Though very rare, all forms of anesthesia carry risk of severe complications such as infection, bleeding, drug reactions, blood clots, paralysis, stroke, brain damage, heart attack, or death. Your healthcare providers will help you choose a form of pain relief that gives the most benefit, with the least risk, for you and your baby.